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Stepping it up for better mental health care

November 7, 2012

The NHS 15 Steps Challenge is a unique tool to improving quality of care in inpatient mental health environments, argues Louise Randle


Having worked as a mental health nurse for over 16 years, I have seen many initiatives aimed at improving the service user experience. Whilst many of these initiatives have involved service users, the 15 Steps Challenge for mental health inpatient care toolkit is unique in that it puts service users at the forefront of making improvements.

Developed by the NHS Institute for Innovation and Improvement the 15 Steps Challenge encourages organisations and their staff to view and understand how the quality of the care they provide is seen through the eyes of their service users, helping them take simple steps to improve the experience for both service users and their carers.

Co-produced with service users and staff, the 15 Steps Challenge toolkit was created following feedback from a mother whose daughter was a frequent inpatient on an acute ward. She could tell what kind of care her daughter was going to receive within just 15 steps of walking on to a ward.

The 15 Steps Challenge guides service users, carers and NHS staff through the first impressions of a mental health inpatient setting using a series of questions and prompts. The toolkit helps demonstrate what good practice looks like and promotes sharing this throughout the organisation. It actively helps improve engagement between service users, board members, carers and staff.

Nottinghamshire Healthcare Trust first got involved with the 15 Steps Challenge earlier on this year when we were approached by the NHS Institute to be a test site to help develop the Challenge toolkit for mental health inpatient care, and also help test a version produced specifically for community services.

As the Trust has a large forensic directorate consisting of 42 wards, a large proportion of which are located in a high secure environment, we were able to give a particular focus on whether the tool could be used effectively in these settings.

The key difference between the 15 Steps Challenge and other initiatives is the way in which it gives service users and carers a voice in relation to improving mental health inpatient experience.

Many initiatives are aimed at improving service user experience but by inviting service users and carers to play such a significant part as the 15 Steps Challenge does, it allows service users to be part of the challenge team and at the forefront of improvement, enabling them to drive it.      

At Nottinghamshire Healthcare Trust the 15 Steps Challenge has allowed us to consider first impressions of a clinical environment and consider the influence that these have on service users.

When our teams undertake ward walkarounds, which are part of the Challenge, they are taking time to consider service user experience from a practical viewpoint e.g. what do service users hear, see, smell when they go onto a clinical environment, and how does it make them feel? I have not come across an initiative before which encompasses this. Most initiatives work in the past tense and often service users are asked about their experiences at discharge or towards the end of a treatment or intervention, this focuses on real time experience and the feedback is given on the day.      

Service improvement is more of a challenge now than ever before due to the financial restraints that the NHS is currently under. It is a challenge for all inpatient areas to be efficient whilst ensuring quality is not compromised.

Mental health services are feeling the strain of ?do more with less? just as much as other areas of the NHS. The 15 Steps Challenge gives us an objective view on whether certain initiatives are effective and whether they are having a positive impact on service user experience  At Nottinghamshire Healthcare Trust the overall aim for the 15 Steps Challenge is to improve patient experience by achieving:

* involvement of patients and carers in service developments
giving patients and carers a voice regarding their experience of the service
* real time feedback and quick action regarding the issues raised during 15 Steps Challenge visits
* assist in the sustainability and progression of other initiatives such as The Productive Mental Health Ward/Essence of Care
* raise the profile of the importance of first impressions and experiences of the service.

Following the testing stage of the 15 Steps Challenge Nottinghamshire Healthcare Trust have put together a schedule of visits for the forensic division which will see all wards visited twice a year initially.

We will then spread the initiative to other areas of the trust which includes in-patient settings and community teams. The Trust has a pool of people that will play a part in the Challenge team including nurse consultants, matrons, executive team members, governor members, service users, and carer representatives.

There has been a very positive response to the 15 Steps Challenge across the division, raising the profile of first impressions has already empowered staff members to review and make changes to their environment and it is already assisting the sustainability of the work the Trust is currently undertaking on The Productive Series.      

* Louise Randle is Acting Releasing Time to Care Trust Lead at Nottinghamshire Healthcare NHS Trust

* More details on the 15 Steps Challenge:

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